"Many things we need can wait. The child cannot. Now is the time his bones are formed, his mind developed. To him we cannot say tomorrow, his name is today." - Gabriela Mistral

Thursday, November 15, 2012

One, Two, Three

Recently, I spoke to a school directress about places for Little A in their next year's programme. She asked, when I explained he was on the Autism Spectrum, whether this diagnosis had been given by a developmental pediatrician or a neuropsychologist. I replied that it was the former, as I'd not even been referred to any of the latter. It turns out there are only two of these in the Philippines, and I'd already inquired at one of them three years ago. She has a two year wait list, or so, so we'd just gone with the developmental pediatrician, who was able to give us an appointment within two months.

Apparently, neuropsychologists perform an entirely different set of tests on a child and give therefore a more accurate diagnosis. I never knew this, as even the request for a referral to a dev ped was on my initiative, and not something that was suggested by our regular pediatrician, as it maybe should have been, much sooner.

I would still like to have Little A's diagnosis verified, and am now considering going back on that wait list. Lately though, he has made good improvements in his social interaction skills, which is a very enouraging sign for his further progress.

There is a tripod that puts a child on the spectrum, and initially Little A fit all the categories. First is communication, or, more accurately, lack thereof. A child who doesn't speak by age 2 is a red flag. While Little A still doesn't speak functionally, he does now communicate fairly effectively with gestures, word cards or letter pieces, and a keyboard. He still lags behind in storytelling, but that is hopefully the next step. He can show us how he feels and what he wants, which is considered the most important thing.

The second "leg" is social interaction. Autistic people are most commonly described to be "in a world of their own," and have to be taught social niceties, including how to play appropriately with others. Little A didn't properly interact with other kids for a long time, but would parallel play, tolerate, and acknowledge their presence. Lately though, he's been initiating contact. He would see kids outside playing with balls and run out to join them, happily watching and asking to take a turn. When they would tell him to duck down out of the way, down he would go instantly, sitting on the floor, which wasn't exactly right, but showed he was listening and reacting to instruction. He has been practicing turn-taking as well.

What hinders him though from engaging fully with his peers is the third part of the tripod - behaviour. Some autistic people take comfort in flapping their fingers, others tap or bounce. This is a way to help them process their surroundings and cope with the world, not much different from when a typical child lugs around a security object or sucks a thumb. But since they are different, they tend to be more extreme, more rigid about these behaviours, and so the real challenge is getting rid of them while the child still manages to process all the surrounding stimuli.

In Little A's case it is clapping. He's been working so hard to manage this, but still tries to control it, running up to someone who claps and putting their hands together "his" way - silently, fingertips of one hand to palm of the other. If the applause is constant or unexpected, as when a musical number ends or a sports team scores and too many people clap than he can "control", he runs away, upset, and screams and cries for a while.

Sometimes it is also counting that triggers outbursts. Right now there are certain numbers he likes, and if he hears someone calling out another number, he wants them to say the number he likes, and points to it or spells it out, waiting patiently until the person obliges or getting angry if they don't. This requires a fair amount of tolerance on both sides.

We are working with his team to get him used to the fact that he will not be able to control his surroundings entirely. It's hard work, but he's working harder than any of us, I think. We're thankful for small steps forward, despite the steps back. Little by little, thinking he can, chugging up the hill, will get him there.